DESCRIPTION (provided by investigator): This application is aimed at understanding the molecular basis for the neurodegenerative disease Friedreich's ataxia (FRDA) and development of novel therapeutics. FRDA is one of the triplet-repeat diseases, where expansion of GAA.TTC repeats within the FXN gene, encoding the essential mitochondrial protein frataxin, leads to epigenetic transcriptional silencing. Loss of frataxin results in a spinocerebellar ataxia with secondary cardiomyopathy, which is the major cause of death in FRDA patients. At present there is no approved therapy for FRDA. Since the GAA.TTC repeats are in an intron, and do not affect the sequence of frataxin protein, gene activation would be of therapeutic value. We identified members of the 2-aminobenzamide class of HDAC inhibitors as potent activators of FXN transcription. These molecules cross the blood brain barrier in mice and canines, exhibit no acute or chronic toxicity, and increase FXN mRNA and frataxin protein levels in the brain and heart in the mouse FRDA model, as well as in circulating lymphocytes in drug-treated FRDA patients in a Phase Ib human clinical trial. While these data provide a proof of concept for this therapeutic approach, our current compounds suffer from pharmacological limitations that preclude their use in chronic treatment. Through a medicinal chemistry effort, we have identified new compounds that have solved these limitations, and one such molecule is being taken forward as a new clinical candidate. During the previous application period, we generated induced pluripotent stem cells (iPSCs) from FRDA patients and differentiated these cells along the neuronal lineage. We have used these cells to model FRDA to study FXN gene silencing and for drug screening. In the present application, we plan to (1) optimize methods for the differentiation of hiPSCs to sensory neurons, the major cell type affected in FRDA, and to use these cells to model the disease through global gene expression studies and markers of mitochondrial dysfunction. For these experiments, we will use helper-dependent adenovirus-mediated homologous recombination to generate isogenic cell lines have the GAATTC repeats corrected to normal lengths. (2) Since cardiomyopathy is the major cause of death in FRDA, we will also model the disease in FRDA iPSC-derived cardiomyocytes. (3) We will use these two FRDA cell models to ask if improved HDAC inhibitors can reverse FRDA gene expression signatures and FRDA mitochondrial pathology. (4) Lastly, we will use neuronal cells and patient lymphocytes to identify gene expression biomarkers to be used in Phase II efficacy studies in FRDA patients. Our studies are at the forefront of development of a novel therapeutic for this currently untreatable and lethal disease.